Demonstration Project Data Called 'Unreliable'

WASHINGTON—Medicare's 2005 chemotherapy demonstration project cost the Centers for Medicare & Medicaid Services (CMS) about $220 million, with beneficiary liability totaling approximately $55 million. But the data collected proved unreliable, according to a report by the Department of Health and Human Services' Office of Inspector General (IG). The project continued in 2006 with significant modifications.

Providers in 2005 received $130 each time they reported an assessment of a patient's level of nausea, vomiting, pain, and fatigue through the claims system, with beneficiaries responsible for 20% coinsurance. About 90% of eligible providers took part, and 85% billed the demonstration codes at least half the time.

In its assessment, the IG's office found that 7% of the claims did not comply with project rules or were paid incorrectly, which resulted in $17 million in net overpayments. The median amount allowed per physician was approximately $23,000, but the top 10 billers were allowed more than $270,000 each.

It further found that CMS failed to sufficiently define the parameters of the demonstration, which led to inconsistent data collection and incomplete and unreliable data. "Because CMS did not mandate a specific approach to collecting the demonstration data, oncology practices implemented inconsistent data collection procedures. We identified numerous anomalies and gaps in the data and collection methods that demonstrate the unreliability and undermine the usefulness of the data," the report said.